If the state of Texas was a student in your reproductive health class, it would be the one who walks in late everyday, sits in the back row, and proceeds to shoot spit balls at the teacher throughout the lecture. The grades are in, and for the second year in a row, Texas received an F- on the Population Institute’s third annual report card on reproductive health and rights.

For the past three years, the Population Institute—a D.C.-based think tank that promotes access to family planning information, education, and services—publishes the report card as a way to gauge reproductive health around the country and within each state.

They measure each state against nine criteria across four broad categories:

EFFECTIVENESS (30 points): Statewide, what percentage of pregnancies is unintended, and how high is the state’s teenage pregnancy rate?

PREVENTION (20 points): Does the state promote comprehensive sex education in the schools, and does it support access to emergency contraception?

AFFORDABILITY (30 points): Does the state have policies designed to make birth control affordable to uninsured and low-income individuals?

ACCESS (20 points): Does the state impose harassing or burdensome requirements on those seeking family planning or abortion services?

While the U.S. as a country actually improved its grade from a C- to a solid C, the number of failing states has increased each year. Fifteen states failed to meet the Institute’s standards this year, compared to 13 in 2013 and only 9 in 2012.

There are no real surprises hidden within the report card. The states you would imagine receiving an A—California, Oregon, Washington, and Texas’s neighbor, New Mexico—have the highest scores. The 15 failing statesincluding Oklahoma, Louisiana, Mississippi, Alabama, and Texasare also unsurprising. We’ve seen these states make headlines over the past few years for things like passing highly restrictive abortion limits, refusing to expand Medicaid under the Affordable Care Act, or failing to teach students what an STI is.

Texas’ score isn’t as low as the fourteen other failing states—Texas only missed the passing mark by a tenth of a point—but the state was one of only two slapped with an F minus because of extra factors that aren’t necessarily reflected in the scoring criteria, like the restrictive abortion provider requirements set by HB2. The breakdown of Texas’s grade shows that we received zero points in three categories: sex education, Medicaid expansion, and abortion restrictions. The only category the state earned full points in was for its teen pregnancy rate, which has been declining steadily since 1990 and, at 73 pregnancies per 1,000 women, is currently below the goal of 78 set by Healthy People 2020.

Zero points were given to sex education because, since 2009, Texas hasn’t required sex-ed as a graduation requirement for high school students. Individual districts can choose to require it, but even in these cases, the programs are largely abstinence-based, rather than the highly-recommended, and much more effective, comprehensive programs for which President Obama’s Teen Pregnancy Prevention Initiative provides funding. When students are subject to sex-ed, the state doesn’t require that the class be medically accurate or leave out religious and cultural biases.

Over the past few days, there’s been talk that Governor-elect Greg Abbott might be looking to expand Medicaid, but those rumors have been quickly dispelled by his spokeswoman, Amelia Chase, who recently said: “Fear not—Governor-elect Abbott has fought Obamacare and will continue to fight against it.”

The only other state to receive an F- was Alabama, which also has abortion restrictions and, like Texas, chose not to expand Medicaid under the Affordable Care Act. 

The silver lining in all this is that there isn’t a grade worse than an F-, so our report card can’t get any worse.